The blessed, damned machinery – #DBlogWeek ’16 – Day 4

 

There was a time that I hated going to the endocrinologist’s office. I thought their ways of doing things archaic and ineffective. For years, a visit to the endo was like a visit to my first grade classroom. It was a time warp back to the days of dusty chalkboards, motivation by intimidation, and a teacher who stood tall at the front of the room, making the rest of us seem very, very small.

And so it was, from my first endo visit back in first grade, up until about five years ago.

Illegible notes from my very first meeting with my very first endo — upon diagnosis 35 years ago from Saturday.

How would my doctor sketch this on his computer? He can’t!

My current endo’s office is modern and up-to-date. And I am generally very happy with my visits there. But sometimes, the little parts of the visits drive me up a wall.

 * * *

Here’s how it goes.

First, I arrive in the waiting room. After checking in with the receptionist, they take my pump and CGM, and walk it somewhere in the back to download the data as I have a seat.

I absolutely hate sitting there without my pump and CGM at (or in, as it may be) my side; even for just a few minutes.  Although “a few” minutes usually turns into ten or more, because of some glitch or difficulty in downloading the data (or because, like airplanes waiting to take off at Newark Airport, there are five or six units in front of me in line).

I’m not a person who generally feels anxiety over anything, but not having those tools with me really messes with my mind.  How much insulin am I not getting? What if I go low? What if they mix up my pump with a different patient’s?

Lately, I’ve tried to preoccupy my mind by trying to figure out how far I, in the waiting room, can be from that secret back-room (actually, a somewhat open nurse’s station) and still have my CGM sensor detected. I’ll scope out all of the seats in the waiting room, coming to the baffling confusion that the chair that is farthest from the door is actually the only one with close to a straight line-of-sight to where my Dexcom receiver is sitting.

 * * *

Finally, they call me back to an exam room. Sometimes I get my pump and CGM back beforehand, sometimes after.

(Now comes the part that still is archaic, but perhaps shouldn’t be) It’s time to get weighed.  My pockets are filled with all kinds of crap and my shoes are on.  Do I take them off? They offer no guidance. My weight always hovers right around one of the notches where the big (50-pound increment) weight on the bottom bar of the doctors’ scale goes; if I tip the scale the right way, the nurse just fine-tunes the slider on the top bar and we’re good.  If I’m wrong, she has to move the bottom weight and then try to adjust the top all over again. Eventually, she comes up with the weight that goes on the chart, even though I see the balance-thing is still wobbling violently, and she can’t possibly be right.

Not that I worry about my weight. It’s really not a cause for concern to me. But it’s the same routine, over and over.

 * * *

Except lately, the number isn’t written in a chart. It’s typed in a computer.

I thought that going to computer-based recordkeeping would be a good thing. Turns out it’s not.

As I learned, having the doctor sit across from me, with the paper on the table in between, encourages interaction, eye contact, and trust.

When the doctor and I sit side-by-side, staring at the computer monitor hanging on the wall, there is no eye-contact. There are no facial expressions. The focus isn’t on the information being charted, but on the particular format, field, and character limits that allow it to be done. And don’t forget to save – or it has to be done all over again.

Finally, it comes time to go over my downloaded data (CareLink reports).  As it used to be, the doctor would look through the stacks of paper, and with his trusty Bic ballpoint pen would circle areas of interest or concern.  Sometimes he’d write notes on the sheet; sometimes he’d put two pages side-by-side so he could analyze one in the context of the other. We’d look at each other and talk about the data as he did this. Together, we’d come up with strategies and action-plans. I’d request a copy, notes and all, when I left.

Nowadays, the data is on the screen. We don’t look at each other – we look at the screen. When we talk, we talk to the wall – literally – but only during the silence between keyboard-clatter. The ad hoc extraction of most-relevant sheets is replaced by a frantic PageUp/PageDown regimen. And the Bic ballpoint is replaced by committing observations and strategies to memory – for the moment anyway. Eventually, these things must be typed into the proper field on the proper form, hastily and without interruption, before they are forgotten. Rather than a participant in the process, I’m now merely an spectator.

We don’t review my CareLink reports like we used to.  I don’t know if my doctor notices the difference, but I do. It’s not nearly as effective. I don’t like it.

 * * *

Some time later, I usually get an email telling me that I’ve gotten an important message from my doctor. The email doesn’t tell me anything other than the hoops I need to jump through in order to view the message: I need to log into some secure portal (which is not mobile-friendly) with my unique username and password (which I can never remember), and then find the hidden link that tells me where to find my messages.

Usually, it’s something stupid like a confirmation that a refill of my Synthroid prescription was sent in, or that my bill was paid (sometimes I pay at the time of service, sometimes they bill me. I can’t figure it out). It might be more important, but usually not.

 * * *

My doctor is really at what he does, and I’m grateful to have found him and become a patient of his. But sometimes, the technology (or lack thereof) really gets in the way of him performing his magic.  Sometimes, people accept their procedures as a necessary part of doing business — but I think it’s worth stepping back to see what’s working. And then fixing it. For everyone’s benefit.